title: [The clinical analysis of a step-up approach for severe acute pancreatitis: report of 121 cases].
abstract: OBJECTIVE
  To investigate the feasibility and clinical value of the step-up approach for severe acute pancreatitis (SAP).
  
  
  METHODS
  Clinical data of 121 SAP patients admitted between January 2002 and December 2011 were retrospectively analyzed. Fifty-eight patients (37 males and 21 females, aged from 20 to 72 years, mean 47.6 years) in the group of direct open necrosectomy from January 2002 to December 2006 were performed laparotomy through removal of all necrotic tissue. Sixty-three patients (42 males and 21 females, aged from 19 to 78 years, mean 46.2 years) of step-up approach from January 2007 to December 2011 underwent percutaneous catheter drainage through retroperitoneum or omental bursa guided by B-type ultrasonography for the first therapy, and then, according to the pathogenetic condition, if necessary, followed by a small incisional necrosectomy along the drainage tube. The two groups were compared for the rates of postoperative complications, death, transfusion and length of stay, medical costs.
  
  
  RESULTS
  The rates of total postoperative complications, organ dysfunction, alimentary tract fistula and incisional hernia in step-up approach group were significantly lower than those of direct open necrosectomy group (31.7% vs. 62.1%, 14.3% vs. 37.5%, 6.3% vs. 19.0%, 9.5% vs. 29.3%; χ(2) = 4.43 to 11.17, P = 0.001 to 0.035). The other complications had no significant differences between the two groups (P > 0.05). Patients in step-up approach group had a lower rates of transfusion (44.4% vs. 70.7%, χ(2) = 8.488, P = 0.004), fewer medical costs of transfusion and hospital stay, compared with those in direct open necrosectomy group ((2525 ± 4573) yuan vs. (4770 ± 6867) yuan, t = 2.131, P = 0.035; (171 213 ± 50 917) yuan vs. (237 874 ± 67 832) yuan, t = 2.496, P = 0.014). There were no significant differences of length of stay and mortality between two groups (P > 0.05).
  
  
  CONCLUSIONS
  Step-up approach for SAP which can reduce the rates of postoperative complications, transfusion and medical costs has significant feasibility and great clinical value.
authors.affiliation: Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (Email: sunbei70@tom.com).
authors.forename: Bei
authors.initials: B
authors.lastname: Sun
authors.forename: Zeng-Fu
authors.initials: ZF
authors.lastname: Song
authors.forename: Hong-Chi
authors.initials: HC
authors.lastname: Jiang
authors.forename: Xue-Wei
authors.initials: XW
authors.lastname: Bai
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Tan
authors.forename: Rui
authors.initials: R
authors.lastname: Kong
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.forename: Lin-Feng
authors.initials: LF
authors.lastname: Wu
authors.forename: Pan-Quan
authors.initials: PQ
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000191:economics / Q000601:surgery*; D019152:Paracentesis / Q000191:economics; D010529:Peritoneal Cavity / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult